COVID-19 Questions: Dr. Ferdinando Mirarchi

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During the Coronavirus pandemic, it is easy to be cynical. News is constantly coming at us in real-time, 24 hours a day. Everything is fluid, and because it's fluid, everything can change. It's important to be mindful of this especially with children – and what they're listening to in the news. Thankfully, there are individuals on the front lines who are trying to navigate these waters, to comb through and crystalize the mass information we are continually receiving. One of those individuals is Dr. Ferdinando Mirarchi. 

Dr. Mirarchi is a local emergency medicine physician, the Chief Medical Officer at the Institute on Healthcare Directives and Founder of MIDEO, a software approach that provides patients and medical providers a Medical Directive, portable in the form of a personalized ID card. I recently had the opportunity to talk with Dr. Mirarchi, and to receive some clarity and insights into the Coronavirus in order to hopefully better answer some of the ongoing questions and concerns that continue to circulate in the news and throughout our communities.

Rebecca Styn: In navigating the world of misinformation, what news is out there that is being miscommunicated, or that others might not be fully understanding. 

Ferdinando Mirarchi, DO: So, first and foremost, the disease has been here and essentially there's been a very limited amount of testing in the nation. So, when you look at the numbers of the nation, quite frankly, if we publish a million cases, there are probably 10 million cases. And the reason I say that is because the amount of testing has been restricted to people who have had a fever, who've had typical exposures, true exposures to COVID positive people. So, the reality of it is that even though everybody is saying there are numbers of deaths and they're predicting the number of deaths, you have to take that death rate and make people realize that the percentage of deaths from this is lower than what we're publishing because we have such limited testing. So, the N size (total number of cases) is so much greater in theory and then what is being published.

RS: Do you think the disease has been in our community for longer than we believed it to be?

FM: Yes. We [at the Institute] had suspicions that it's been in the community, but again, the community has had such limited ability to test that if we say we only have 20 in the community, there's much more. And that's why all the recommendations are coming out to really hunker down and shelter. Because even when the new rapid testing comes out, there are only 50,000 tests [manufactured per day]. So, they have to divvy up 50,000 tests across the nation until they can produce more reagent and more testing strips and so on. So, the reality of it is, is that we have people who are either asymptomatic or who have conditions and are healthy. And we just tell them to shelter or self-quarantine because we have a high suspicion that it's here. But we can't really waste a test on that individual because there's a sicker person that we need to get that answer from.

RS: Trump recently extended the federal social-distancing guidelines to April 30th. Do you think it will go past that date?

FM: So, everything's projected upon New York. And everybody predicts that we're about a week away from New York as far as seeing large amounts of cases. And if that is the case, New York's not really expected to peak until the next two weeks and maybe even the third week of April. So, if that's the case, we may be sheltering in place longer than April 30th. 

RS: Recently we have been told to start wearing masks. Are you in full support of all the recommendations that have been made to date?

FM: There are merits to this approach in that many who are COVID positive will be asymptomatic. So in that population, by wearing a mask, you could limit spread. Remember masks prevent others from getting sick but don't really keep you from getting sick. They are beneficial to prevent you from infecting other people. And the reason they're making this recommendation now is that people who are asymptomatic, are positive because they haven't really exhibited symptoms yet. So, and when you look at what happened in Seattle in that one nursing home where there have been dozens of deaths, 50% of patients were asymptomatic [but positive] and that's what propagated all that other illness that developed because those asymptomatic people then started to affect others and then started to get symptomatic themselves. 

RS: Both individually and as a society, do you think there's anything we could be doing that we aren't doing right now?

FM: As a society and even individually, people are still figuring out ways to break the shelter in place regulations, right? Again, a small group of people who are distancing themselves is not the biggest concern. It's when people get together in larger numbers. In parks and so on because kids are home and they're co-infecting each other. The reality of it is that people aren't really following the small group recommendations. And, I think, that's why they got more aggressive with the shelter-in-place.

RS: We are receiving a lot of mixed messages on how long this virus lives in the air and on surfaces. Can you clarify this better?

FM: An MIT researcher stated the virus can travel 27 feet. You're not going to be getting infected from somebody that's 27 feet away from you. Remember that 6 feet is a generous distance to keep feeling safe. If you keep the six-foot distance, you're going to be well-protected. The other thing that we want people to know is that recovery is the norm. The virus is getting beat. 85% of people are getting better. Even 85% of the elderly population is getting better. We know that people with high blood pressure, heart disease, lung disease, on chemo, on immunosuppressive type agents, we know they're at risk.

And we need to make sure that they don't get sick. Because if those people do get sick, they'll most likely end up in an ICU. And a high percentage of those, 20-25%, will end up on a ventilator. And that's what we need to protect. Now, there will be some people, who are younger, who may also get that sick and oftentimes that's somebody who's got an unknown condition that this virus took advantage of.

RS: How do you think our local health systems are faring?

FM: So, everybody's taxed, but systems have had the good fortune to see this unfold elsewhere first. Locally, our health systems are working aggressively to make sure they're getting personal protective equipment and making sure their staff are safe and to make sure that patients are going to be taken care of.

RS: Let's say you live with somebody that comes down with the virus, but it's someone you need to take care of - what's the best way to protect yourself during that time?

FM: So, if they need to be taken care of, then it's essentially you as the care-taker. You will need to protect yourself as well. You should try to mask the individual. You should wear a face covering. You should aggressively wash your hands. And most importantly, we do know that touching your eyes, nose, face, mouth and I would even add ears – because everything's connected through different anatomical channels – will get you infected So, it's really important that you wash your hands and it's really important to sanitize and it's ever so important to not touch your face.

RS: How about the recommendations that have been made for wiping down mail and bags of groceries? 

FM: A lot of people are trying to make those recommendations and I don't know if they're really going to be beneficial or not.  In theory yes. On paper, the virus can live for about 12 to 24 hours, as far as contact. Other surfaces longer. So, some people are recommending putting their mail in a bag for three days and just letting whatever viral particles die off. Other people are making recommendations to actually wipe down the mail with a Clorox agent or some peroxide agent. I don't really condone one thing or another. Most importantly to me, is if you're going to touch your mail, wash your hands. Even three days from then, if you're going to bag your mail or wipe it down, after you get through your bills, wash your hands. Don't touch your face and wash your hands. I can't say this enough.

RS: What else do you think is essential for the community to know right now?

FM: There are two things that we have to be concerned about right now, with this virus and people getting sick alongside the lack of ability to see your loved one. One is that there will be a certain percentage of people that will need to go to an ICU. There will be a certain percentage of people who go on ventilators. There will also be a certain percentage of people who will have cardiac arrest. In this pandemic, with visitation restrictions, you most likely will only get one chance to receive aggressive treatment and we need to make sure that whatever care you receive is the right care for you. If you have a living will, we know that these can get misinterpreted 80% of the time as DNR orders. That misinterpretation can lead to you not receiving aggressive life-saving care early on. A solution we developed is known as a MIDEO® [My Informed Decision on VidEO] which contains an embedded video recording of the patient's emergency medical care wishes and will inform a physician or emergency personnel exactly what they need to know quickly and without guesswork take care of you. There is still time to create one and it can be done through telemedicine to minimize your risk exposure. If you choose not to do MIDEO then remember the following: If you are asked questions about treatment when you are in cardiac arrest, be careful of how the question is asked. They tend to phrase it as if it's a terminal illness vs a critical illness. Most patients will accept treatment when critically ill. You will need to make that clear. The same goes if you have a living will. I can assure you if you look frail, with gray hair or have medical conditions that these questions will be asked of you. Be aware that if you or family are COVID positive and a cardiac arrest develops, they may choose to not do CPR as the survivability is exceedingly rare and it could infect and harm healthcare providers.

Have a conversation with your mom and dad, spouse, your kid and have a plan. Decisions during a pandemic can be similar to what we do in times of war or natural disasters. This pandemic is for sure a natural disaster and essentially in those kinds of situations, decisions get to be more hierarchical or unilateral. So, having that conversation with your family members about how they want to be treated when they're going to be sick or critically ill is going to be really important, so that, at least, there's a framework for your decisions.

Rebecca Styn is VP of Ventures at Erie Innovation District and is the proprietor of Room 33 Speakeasy. She is also completing her Ph.D. in Leadership and Organizational Learning from Gannon University. Follow her on Twitter at @rstyn.